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Campus Researchers Try New Ways to Close a Gap in Mental-Health Care

Undertreatment among nonwhite populations is common because of cost, lack of availability and stigma of seeking care

Academic researchers are trying new ways to bring treatment for mental illness to students from ethnic-minority backgrounds, who experts say may experience a sense of isolation and barriers to seeking help.
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Corbis

As college campuses grapple with mental-health issues, researchers are trying new ways to bring treatment to students from ethnic-minority backgrounds, who experts say often don’t get the care they need and are more likely to have negative consequences due to their illness. Even highly educated minority students tend to seek care for mental-health issues less frequently than whites.

Academic researchers and foundations such as the Steve Fund are trying to improve the quality of mental-health care for ethnic-minority populations and their engagement with it. They want to bring treatment to the patient rather than waiting for a person to come to a traditional health setting, and they are using technology as an alternative to face-to-face treatment.

Dr. Margarita Alegria, chief of the disparities research unit at Massachusetts General Hospital, where interventions and studies aim to help ethnic-minority patients feel more supported by clinicians and improve communication.
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Thomas McGuire

Undertreatment of ethnic minorities has long been a concern in the mental-health community, highlighted by the first-ever Surgeon General’s Report on Mental Health issued in 1999. Common universal barriers such as cost, lack of availability and stigma against seeking mental-health care are compounded for some ethnic minorities by mistrust of the health-care system, racism and difficulties with language and communication, according to a supplemental report on culture, race and ethnicity issued with the Surgeon General’s report.

Most of these barriers are still a problem today, according to mental-health experts. Minorities are likely to wait longer with symptoms before seeking care compared with whites, and they are more likely to drop out of treatment, making retention an important goal for professionals. Generally, though, if they receive good care, outcomes are similar for ethnic minorities and whites, experts say.

Research suggests that minorities often prefer counselling or talk therapy to medication yet they often don’t have the opportunity because of limited service options. If offered medication and willing to try it, however, they respond as well as whites, says Jodi Gonzalez Arnold, a psychologist and professor in the department of psychiatry at the University of Texas Health Center in San Antonio, who has studied the issue.

Of course, not all ethnic minorities, both within and across subgroups, are the same, and there is a need for improving mental health universally. Still, “clinicians should be aware not only of within-culture norms but also what does the research shows across cultures to make a decision based on the totality of the information,” says Dr. Arnold.

Lower educational levels and tough economic circumstances are barriers for some racially and ethnically diverse populations. But the disparity in treatment-seeking exists even among highly educated individuals from these populations, such as college students at elite universities, research shows.

Abhilasha Belani, a 22-year-old recent Stanford University graduate, says many of her ambitious, high-achieving classmates had difficulty admitting when they were struggling and needed help. They dubbed the pressure to look in control “duck syndrome”—looking calm on the surface but paddling furiously underneath.

While there are countless differences between and among members of different ethnic groups, children of immigrants of Asian heritage seem to have particular trouble asking for help because to do so has been seen as a failure, says Ms. Belani, who was born in France to Indian parents and worked as a peer counselor and residential adviser while at Stanford.

In her junior year, Ms. Belani found herself struggling alone with stress from academics and extracurriculars, which led to increased anxiety. She went to the school counseling center but after being encouraged to seek out a therapist in the community on her own, she says she “lost motivation” and didn’t pursue the lead.

Because she worked in counseling, she eventually cobbled together support from other peer advisers and faculty members, who became mentors and helped her learn to take better care of herself, she says.

Students from ethnic-minority backgrounds need more support alternatives, some advocates believe. A new initiative, to be launched by the Steve Fund, one of the few groups focused on supporting the mental health of college students of color, and a website offering online therapy called 7cups.com, focuses on offering them emotional support online.

The goal is to offer a first step for students of color having emotional or mental-health concerns. It is a way for them to talk with someone and get encouragement in an environment where a person may feel isolated, says Annelle Primm, a psychiatrist and senior medical advisor to the Steve Fund. Interventions focused on specific populations are intended “not to stigmatize or separate or segregate,” Dr. Primm says, “but to have the capacity to communicate with a diversity of populations.”

So far about 1,500 volunteers have received training as listeners. The service is expected to launch in February, according to fund president Evan Rose, whose family started the Steve Fund for his brother, a Harvard College graduate who died from suicide in 2014.

Academic researchers at Massachusetts General Hospital have been running interventions to improve patient-clinician communication and help ethnic-minority patients feel more supported by clinicians who may or may not share their ethnic or cultural backgrounds. One trial of 278 patients and 48 clinicians that has been taking place over the past 2.5 years is aimed at training providers to do more shared decision-making with minority patients, as a way to decrease the “interpersonal gap” minority patients often describe experiencing with health-care providers.

The intervention is trying to give patients a stronger voice, such as telling a clinician which topics they want to discuss during a session. And it is training clinicians to be more responsive and to make fewer assumptions about patients’ feelings, especially because there might be cultural differences in how people express emotion.

The trial is nearly complete. Scientists will be analyzing the outcome of the data in coming months, says Margarita Alegria, chief of the disparities research unit at Massachusetts General Hospital and a Harvard Medical School professor of psychology.

Another intervention, funded by the National Institute on Aging, is trying to train health workers in community agencies that serve the elderly, many of whom are ethnic minorities, on how to provide evidence-based mental-health interventions for depression and anxiety, sleep and nutrition, in Chinese, Spanish and English. The study, called “Positive Minds, Strong Bodies,” increases often-limited resources for providers and takes place in settings where patients are already going, rather than referring them to a new provider or a clinic.

“Rather than wait the average eight years that people with behavioral health problems wait before they get to care, we should move treatment where people are to serve them sooner,” Dr. Alegria says.